2004 Volume 2 Issue 1 Pages 7-13
Background. We investigated the effect of congestive heart failure (CHF) and pseudonormal (PN) hemodynamics on the TEI index in patients with left ventricular (LV) systolic dysfunction.
Methods. Study 1 included 12 patients with LV systolic dysfunction who were admitted because of CHF, and study 2 included 42 patients with LV systolic dysfunction whose ejection fraction (EF) was < 45%. Using conventional echo-Doppler methods, the following parameters were assessed: LV end-diastolic volume (LVEDV), LVEF, the ratio of early to late diastolic mitral inflow velocity (E/A), isovolumic contraction time (ICT), isovolumic relaxation time (IRT), and ejection time (ET). The TEI index was calculated as the sum of ICT and IRT divided by ET. In study 1, these parameters were compared between the acute decompensated and compensated stages. In study 2, the patients were divided into PN (E/A>1.2, n=26) and impaired relaxation (IR; E/A<0.8, n=16) groups based on the E/A ratio. The same parameters were compared between these two groups.
Results. Compared with acute decompensated stage in study 1, the mitral inflow profile changed from an E>A to E<A pattern, the LVEDV decreased, and the LVEF increased in the compensated stage. There were no changes in the ET or ICT, a significant prolongation of the IRT, and a significant increase in the TEI index. In study 2, there were no differences in age, LVEDV, LVEF, ET, or ICT between the PN and IR groups. However, the IRT was significantly prolonged and the TEI index was significantly increased in the IR group compared to the PN group. The TEI index best linearly correlated with IRT among various time intervals.
Conclusions. The TEI index showed a paradoxically small value due to a shortened IRT in the acute decompensated stage compared with the compensated stage of CHF. Such pseudonormal phenomena should be taken into consideration in the evaluation of LV function by the TEI index in patients with LV systolic dysfunction.